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Standard-Risk Medulloblastoma Treated by Adjuvant Chemotherapy Followed by Reduced-Dose Craniospinal Radiation Therapy: A French Society of Pediatric Oncology Study

From the Institut Curie, Paris; Institut Gustave Roussy, Villejuif; Centre Hospitalo–Universitaire (CHU) La Timone, Marseille; Centre Léon Bérard, Lyon; CHU Rennes, CHU Nancy; CHU Grenoble; CHU Strasbourg; Centre Oscar Lambret, Lille; CHU Lille; Unité de l'Institut National de la Santé et de la Recherche Médicale U537, Le Kremlin Bicêtre, France; and Hôpital Reine Fabiola, Brussels, Belgium

Address reprint requests to François Doz, MD, Department of Pediatric Oncology, Institut Curie, 26 Rue d'Ulm, 75231 Paris Cedex 05, France. e-mail: Francois.Doz{at}curie.net

OBJECTIVE: The primary objective of this study was to decrease the late effects of prophylactic radiation without reducing survival in standard-risk childhood medulloblastoma.

PATIENTS AND METHODS: Inclusion criteria were as follows: children between the ages of 3 and 18 years with total or subtotal tumor resection, no metastasis, and negative postoperative lumbar puncture CSF cytology. Two courses of eight drugs in 1 day followed by two courses of etoposide plus carboplatin (500 and 800 mg/m² per course, respectively) were administered after surgery. Radiation therapy had to begin 90 days after surgery. Delivered doses were 55 Gy to the posterior fossa and 25 Gy to the brain and spinal canal.

RESULTS: Between November 1991 and June 1998, 136 patients (median age, 8 years; median follow-up, 6.5 years) were included. The overall survival rate and 5-year recurrence-free survival rate were 73.8% ± 7.6% and 64.8% ± 8.1%, respectively. Radiologic review showed that 4% of patients were wrongly included. Review of radiotherapy technical files demonstrated a correlation between the presence of a major protocol deviation and treatment failure. The 5-year recurrence-free survival rate of patients included in this study with all optimal quality controls of histology, radiology, and radiotherapy was 71.8% ± 10.5%. In terms of sequelae, 31% of patients required growth hormone replacement therapy and 25% required special schooling.

CONCLUSION: Reduced-dose craniospinal radiation therapy can be proposed in standard-risk medulloblastoma provided staging and radiation therapy are performed under optimal conditions.

Supported by a grant from the Association pour la Recherche sur le Cancer and sponsored by the Institut Curie, Paris, France.

Presented in part at the 10th International Symposium on Paediatric Neuro-Oncology, June 9-12, 2002, London, United Kingdom.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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